1. Get Into the Loop – Learn About Lupus
Irene Blanco, MD, MS
October 28, 2010
Cherkasky Auditorium, Montefiore Medical Center

2. Agenda Introduction to Lupus Lupus and Your Heart
Dr. Mario Garcia
Question & Answer Session

3. What is Lupus? Autoimmune disease: Excessive immune system activation
Loss of tolerance of immune system to one’s body
Certain genes are more likely to occur in patients with lupus
Many of these genes encode components of the immune system.
Abnormal estrogen metabolism
In animal studies estrogen worsens disease activity and causes early mortality

4. Who Gets Lupus? Female:Male ratio of 9:1 during childbearing years
Closer to 2:1 during childhood and after menopause, suggesting hormonal influence
Disease in males is can be more severe
70% of SLE: females between ages 15-45
10% present age >60

5. Who Gets Lupus? Highest occurrence is in Afro-Caribbean females 1:250
African American to Caucasian ratio 3:1
Child of SLE mother - risk of SLE 1:15 (7%)
10-15% of SLE patients have 1st degree relative with SLE

6. Mortality 90% survive 5 years, 80% 10 years
Renal disease causes worse prognosis
African Americans have more aggressive and treatment resistant disease
Two different causes of death:
Early: disease activity and infections
Late: cardiovascular disease, disease activity, end stage renal disease, and thromboembolic

7. Criteria for the Diagnosis of SLE
Malar (Butterfly) Rash
Lupus kidney disease
Discoid Rash
Neurologic Disorders:
Sensitivity rash to the sun (Photosensitivity)
Stroke, inflammation, depression, memory dysfunction, etc…
Anemia, low platelets and low white blood cell count
Ulcers in the nose and mouth
Arthritis
Abnormal blood antibody levels
Fluid around the heart, lungs and in the abdomen
ANA blood test

8. Malar (Butterfly) Rash
Fixed red, flat or raised, over the bridge of the nose and cheeks
Tends to spare the nasolabial folds

9. Discoid Rash Red raised patches with scaling, skin follicle plugging
Can be very scarring
Singer Seal afflicted with discoid lupus at age 23

10. Photosensitivity
Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation

11. Oral and Nasal Ulcers
Oral or nasopharyngeal ulcers, usually painless

12. Hair Thinning

13. Arthritis
Non-erosive arthritis involving two or more joints, characterized by pain, swelling, or fluid collections
80% of patients have it
Can move deformed fingers back into position
Pain may be out of proportion with appearance

14. Severe or Life Threatening Complications

15. Preventative Treatment
Treatment of SLE
Active Treatment
Preventative Treatment
Topical Steroids
Sunscreen
NSAIDs
At least SPF 30
Advil, Mobic, Naproxen
Calcium, Vitamin D, Folate supplements
Antimalarials
To help prevent SE from other medications
Plaquenil
Influenza Vaccine
Steroids
Pneumococcal Vaccine
Prednisone, Medrol
Cytotoxics/Biologics
Cellcept, Cytoxan, Imuran, Benlysta

16. Side Effects to Lupus Medications
Weight gain
Hair loss, or new hair growth in unwanted places
Damage to the bones
Osteoporosis and Osteonecrosis
High blood pressure
High cholesterol
Low immune system and infections

17. Follow Up Visits How often depends on:
Lupus activity, severity, response to treatment, type of treatment, need for monitoring of medication side effects
At routine visits, blood and urine tests and should be checked
Even in patients with previously normal values
Patients with known kidney disease should also have urine checked every 8 weeks or so